Quality control for invasive cardiology: Holland.

Although no official registration of indications, treatments and results in patients with coronary heart disease has taken place in Holland, the following authorities and commissions have introduced guidelines for quality control: the Dutch government, the Dutch Society of Cardiology, the Working Group on Interventional Cardiology and the health insurers. Until 1991, the right to perform coronary interventions was tied to a license issued by the Ministry of Health. New recommendations were delineated 5 years ago: at least 500 interventions must be annually performed by 5 interventional cardiologists, i.e. ca. 100 interventions annually per cardiologist. No interventional cardiology may be performed without an in-house cardiac surgery and vice versa. In a survey by the Dutch Society of Cardiology on the quality of the Dutch centers, PTCA-mortality was ca. 0.3%, infarction rate was ca. 2%. An emergency bypass operation was necessary in 1.0 to 1.6% of the cases; the surgical team was on immediate alert for 11% of the patients. Selection of patients without risk was deemed impossible. Despite objections by some members the Dutch Society of Cardiology, it was recommended that cardiac surgery and interventions should not be separated. Data from health insurers showed no inappropriate indications for PTCA. The DUCAT-study, which used the RAND criteria, showed PTCA indications to be correct in more than 90% of the cases. The Dutch government wants to control the expansion of PTCA centers, so it is no wonder that waiting lists are becoming longer.